Visits to primary care drop among commercially insured Americans
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Visits to primary care providers dropped by 24.2% from 2008 to 2016, according to research published in the Annals of Internal Medicine.
“Our research group and others had noticed a drop in primary care visits across the U.S. — including among children and older adults,” Ishani Ganguli, MD, MPH, assistant professor of medicine at Brigham and Women’s Hospital, told Healio Primary Care.
“We discovered that visits for problems or chronic conditions dropped while preventive visits — which are mostly free through the Affordable Care Act — actually went up between 2008 and 2016,” Ganguli continued. “This matters for patients because primary care is important for keeping us healthy and out of the hospital.”
Ganguli and colleagues conducted a repeated cross-sectional study using deidentified claims made from 2008 through 2016 from a large, nationwide commercial health insurer. They assessed trends in primary care visits during the study period using a random 5% sample of the claims.
Researchers examined 142 million primary care visits conducted over 94 million member-years. They found that during the study period, PCP visits declined from 169.5 visits to 134.3 visits per 100 member-years — nearly a 25% drop.
The proportion of adults who did not have a PCP visit in the past year increased from 38.1% in 2008 to 46.4% in 2016, according to the researchers.
The rate of visits for low-acuity conditions — including bronchitis, conjunctivitis and urinary tract infections — dropped by 47.7% (95% CI, –48.1 to –47.3).
Although visits for a health problem dropped by 30.5% (95% CI, –30.8 to –30.2) between 2008 and 2016, researchers found that preventive visits increased by 40.6% (95% CI, 39.8-41.4).
Researchers found that the largest decline in primary care visits was among young adults (–27.6%; 95% CI, –28.2 to –27.1), individuals without chronic conditions (–26.4%; 95% CI, –26.7 to –26.1), and people living in the lowest income areas (–31.4%; 95% CI, –31.8 to –30.9).
During the study period, Ganguli and colleagues found that out-of-pocket costs for primary care visits increased by $9.4 (31.5%).
Despite changes in primary care visits between 2008 and 2016, researchers found that specialist visits remained stable (–0.08%; 95% CI, –0.56 to 0.4). Meanwhile, visits to alternative venues like urgent care clinics and EDs increased by 46.9% (95% CI, 45.8-48.1).
Ganguli explained that she and her colleagues identified three main reasons for decreased primary care utilization in the U.S. She said more people with mild conditions may be calling or emailing their primary care office or researching conditions online instead of scheduling a visit; people are avoiding care due to barriers like increased out-of-pocket costs; and more people are visiting urgent care centers, retail clinics and EDs rather than their PCP.
In an editorial accompanying the study, Kimberly Rask, MD, PhD, associate professor in the department of health policy & management at the Rollins School of Public Health at Emory University, explained that cost-sharing measures made by private insurers in recent years may have driven people to avoid utilizing primary care, as they led to higher costs for nonpreventive services.
“The steady decline in PCP visit rates across age, health status, and income may be the unintended consequence of using cost-sharing to reduce unnecessary care in an uncoordinated health care system,” she wrote. – by Erin Michael
References:
Ganguli I, et al. Ann Intern Med. 2020;doi:10.7326/M19-1834.
Ganguli I, et al. J Gen Intern Med. 2019;doi:10.1007/s11606-019-05104-5.
Rask K. Ann Intern Med. 2020;doi:10.7326/M19-4000.
Ray KN, et al. JAMA Pediatr. 2020;doi:10.1001/jamapediatrics.2019.5509.
Disclosures: Ganguli and Rask report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.